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This is a legitimate question to ask: if vaccines work in preventing diseases, why do we say that unvaccinated children are a danger to the vaccinated ones? There are many reasons why unvaccinated children pose a risk to vaccinated children. Here I will go over the main ones:

There are many children that cannot be vaccinated, for various reasons such as an autoimmune disease, allergies, or simply being too young to have received the vaccine. These children have no protection against the disease. If they are exposed to it through an unvaccinated peer, they are at risk of suffering and/or even dying.

Unvaccinated children are protected by the herd immunity created by the vaccinated children. Herd immunity basically means that if enough people are vaccinated it becomes really hard for the disease to find hosts it can survive in and spread. The more children are unvaccinated the greater the risk that herd immunity will fail. If herd immunity fails, all suffer for the reasons described below.

Vaccines do not offer 100% immunity towards disease. The efficacy varies; some vaccines offer higher rates of efficacy, some lower. Having received a vaccine doesn’t guarantee that a child will not get sick when exposed to the disease. Vaccines reduce the risk of contracting the disease, if exposed, dramatically, but there will always be a number of children for whom the vaccine will not provide protection. Those children will be at risk, from other unvaccinated children who may contract and spread the disease.

However, the first and foremost children that are being put at risk by the unvaccinated children, are the unvaccinated children themselves. Before they can become a danger to others, they’d have to contract the disease themselves, and that disease could carry with it all kinds of pain and suffering, including in some cases death.

A recent BBC article, warns parents about the use of so-called homeopathic “vaccinations” instead of real vaccines. Homeopathy is the belief that super-dilutions, to the point where not even a single molecule of the active ingredient is likely to remain, of whatever causes the disease, will cure the same disease. For example, if coffee makes it hard to sleep, a super-dilution of coffee, to the point where it is basically just the water used to dilute it will cure insomnia. Leaving aside the merits of homeopathy as a whole, I can see how someone may think that homeopathic “vaccinations” are just like real vaccinations: in real vaccines the disease-causing virus is used to make a solution which contains a small amount of it to protect against the very same virus. However, the similarities are only superficial. As we will see, homeopathy is nothing at all like vaccines. Here is a short list of the main differences between homeopathy and vaccines:

Vaccines contain small quantities of the weakened or dead virus, or some other part of it used as a signature to train the immune system, in every single dose. Homeopathic solutions, on the other hand, are diluted so much, that it is extremely unlikely that even a single molecule of the substance being made into a homeopathic solution, remains. Effectively, homeopathic pills are sugar pills and contain no active ingredient.

Scientific evidence supporting the use of homeopathic solutions as vaccines, is non-existent. Scientific evidence supporting the efficacy and safety of real vaccines is abundant, and a simple PubMed search will satisfy anyone’s curiosity.

Homeopathy is based on a belief that “likes cures likes”; whatever causes the disease can be super-diluted to cure it. Vaccines are not used to cure diseases, but to prevent them. The weakened virus in a vaccine is used to “train” the immune system to fight the virus when exposed to it. Vaccines are not used to cure an infection after it has happened.

I am sure there are other differences one can point to, but I am certain this is more than enough for anyone willing to look at this issue objectively. The only comment left to make is that taking a homeopathic solution as a vaccine would be equivalent to drinking a glass of water and calling it a pint of beer.

Are parents forced to vaccinate their children? Are vaccines mandatory in the U.S.? This is a question that worries many parents, and it is a claim that is made very confidently by many in the anti-vaccine crowd, and it appears the answer is yes, and no. The CDC has a recommended immunization schedule that most pediatricians follow. That schedule is not mandatory and many parents work with their pediatricians to come up aith alternate schedules, even though they may be going against their pediatrician’s advice when they choose to do that.

Nevertheless, we don’t live in isolation in a mountain top; we live in a society which has rules to protect the whole, and vaccines are no exception. Most states require children to be up to date with their vaccination schedule in order to attend day care centers or public schools (I am not sure how private schools handle this, so for the sake of the argument let us assume they follow the same guidelines as public ones). Those same states, on the other hand, provide opportunities for parents to exempt their children from the vaccination requirements. In this entry we will review the legal requirements, and what exemptions are available to parents when it comes to vaccinating their children.

The best sources of information in regards to this issue that I have been able to find are reports prepared for the U.S. Congress by the Congressional Research Service, CRS, a think tank that provides reports to members of Congress on a variety of topics relevant to current political events, whose mission statement reads as such:

CRS is committed to supporting an informed national legislature — by developing creative approaches to policy analysis, anticipating legislative needs and responding to specific requests from legislators in a timely manner. With a rigorous adherence to our key values, CRS provides analysis that is authoritative, confidential, objective and nonpartisan.

The CRS prepared reports titled “Mandatory Vaccinations: Precedent and Current Laws” which seem to have been compiled by different attorneys at different points in time. For example I found this one, dated 10/26/09 by Kathleen S. Swendiman; this one from Angie A. Welborn last updated on 01-18-05. A couple of earlier versions of Swendiman’s report can also be found at the opencrs website. Keep in mind that these are reports compiled by attorneys and were provided to the U.S. Congress, as such I consider the information in here to be of the highest quality. So what do these reports say about mandatory vaccinations?

The thing to keep in mind when discussing the laws regarding mandatory vaccinations, is that this is mainly a state law issue, as opposed to a federal law issue. With very limited exceptions, “the preservation of the public health has been the primary responsibility of state and local governments“. Also, “current federal regulations do not include any mandatory vaccination program” (Summary).

States on the other hand do have laws in place mandating that children attending day care centers or schools are up to date with their vaccine schedule. The CDC has a nice page with information on mandatory vaccinations by vaccine, by state. Pick a vaccine, pick a level of schooling and you get a table with state-by-state information about the mandatory requirements for the specific vaccine.

If you want to dig more deeply, you will have to research the statute of your state to learn everything on mandatory vaccinations & exemptions. I will not do a state by state analysis, instead I will defer to the Swendiman 10/26/09 report. Here is a synopsis of the main points the report makes:

The preservation of the public health is the primary responsibility of state and local governments, not the federal one.

State/local governments have the power to institute measures such as quarantine, isolation or enact mandatory vaccine laws.

Every state and the District of Columbia has a law requiring children entering school to provide documentation that they have met the state immunization requirements.

Many states provide exemptions for medical, religious, or philosophical reasons (exemptions vary from state to state).

All states allow medical exemptions for those whose immune systems are compromised, who are allergic to vaccines, are ill at the time of vaccination, or have other medical contraindications to vaccines.

Exemptions based on philosophical or moral convictions are less common but are provided by 20 states.

Many states require health workers to be vaccinated; exemptions for medical, religious and philosophical reasons are available to them as well (they vary by state) but not for all diseases.

Many states have laws providing for mandatory vaccinations during a public health emergency or outbreak of communicable disease, especially ones with high morbidity or mortality rates. Exemptions for medical, religious or philosophical reasons are still available, however a person who refuses to vaccinate during the emergency may be quarantined.

At the federal level, no mandatory vaccination programs are specifically authorized, nor do there appear to be any regulations regarding the implementation of a mandatory vaccination program at the federal level during a public health emergency.

So, the answer to the question: are childhood vaccinations mandatory is: Yes and No. Yes, since most states require that children attending day care centers or schools provide documentation proving that they are up-to-date with their childhood immunization schedule, and no because those same states allow many exemptions for medical, religious and philosophical reasons. You may think that’s bad, but consider that in the other hand, child car seat laws are mandatory and do not, to the best of my knowledge, offer any exemptions for any reasons. Thus, to the best of my knowledge, vaccination laws are more relaxed than car seat laws, and car accidents are not contagious. You can judge for yourself if this is a good or bad thing, but the facts remain as described above.

The question of safety is the main vaccine concern. Are vaccines safe? If I vaccinate my child, will that have negative effects for their health? Of course, these questions are extremely broad to be answered all at once. Thus I will be breaking the answers in little bits. Today we will look at the MMR (Measles, Mumps & Rubella) vaccine and autism. Is the MMR vaccine correlated with autism? A quick PubMed search found this study from the June 12, 1999 Lancet (the same journal that originally published and recently retracted the Wakefield study that is widely credited with starting the MMR/vaccine hysteria):

Department of Community Child Health, Royal Free and University College Medical School, University College London, UK

Study Summary: The authors looked at data about autism diagnoses since 1979 and data about MMR vaccinations, which started in 1988 in the UK, to try to see if there is any increase in autism diagnoses in or around the time when the MMR vaccine was introduced. They found that autism rates were steadily increasing every year and no “step-up” in autism diagnoses occurred when the vaccine was introduced, thus lending credibility to the conclusion that MMR does not seem to increase autism rates.

There was a steady increase in cases by year of birth with no sudden “step-up” or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0.94 [95% CI 0.60-1.47] and 1.09 [0.79-1.52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0.92 [0.38-2.21] and 1.00 [0.52-1.95]). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder. INTERPRETATION: Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.

Now, let us keep in mind that, one study never proves anything. At best one study points to a possible direction, no matter how well done, and how rock solid that one study may appear. What matters is the literature as a whole; what do all the studies done on the topic suggest. As such, given that this is the first study about vaccines & autism we’ve reviewed here, let us not interpret this as proof that the MMR vaccine is not correlated to autism. Only when we have found more studies, and only when all the studies appear to reach the same conclusion can we say with any level of certainty that it appears highly unlikely that the MMR vaccines causes an increase in autism levels.

A common question about vaccines has to do with Hep B and goes like this: Heb B is a sexually transmitted disease. Why am I vaccinating my newborn for it? This is not a question without merit, and a very good question to ask. Parents should always be encouraged to seek more information. So, in this entry I will try my best to scour the web for information and come up with a good answer.

It is true that Hep B can be transmitted sexually, however it is not transmitted ONLY sexually. The virus passes from one individual to the other through various bodily fluids, including blood, semen, vaginal fluids, saliva, and other body fluids. Here are some ways in which the disease can spread:

Blood transfusions

Contact with blood in health care settings

Had direct contact with the blood of an infected person by touching an open wound or being stuck with a needle

Furthermore, a baby can get the virus from the mother during childbirth, if the mother is infected.

Hepatitis B virus can survive outside the body at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Effects of Hepatitis B infection

Hep B, is not curable! It comes in two flavors; acute and chronic. Most newborns and about 50% of children that become infected develop the chronic version.

Chronic Hepatitis B increases the risk for liver damage including cancer. Hep B is fatal in about 1% of cases. So on average, if we did not vaccinate, 1 out of 100 children that were infected would die, of this disease alone!

The younger a person is when infected with Hepatitis B virus, the greater his or her chance of developing chronic Hepatitis B. Approximately 90% of infected infants will develop chronic infection. The risk goes down as a child gets older. Approximately 25%–50% of children infected between the ages of 1 and 5 years will develop chronic hepatitis. The risk drops to 6%–10% when a person is infected over 5 years of age.

About 15%–25% of people with chronic Hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer.

Why vaccinate?

I believe, after this short discussion it becomes clear why newborns are vaccinated against this disease at birth. Let me recap:

Hep B is not only transmitted sexually, but through various bodily fluids including blood, and sharing of personal items (something babies are bound to do)

The newborn can catch the infection from the mother during childbirth.

Almost all newborns and 50% of children that contract the disease will develop the chronic version of it.

All these reasons support the decision to vaccinate at birth. Also, it appears the Hep B vaccine may help prevent infection if it is given within 24 hours of exposure , making it even more important to give as soon as a baby is born.

According to the CDC, Hep B infection rates have gone down by about 82% since 1990 when routine Hepatitis B vaccination of children was implemented and has dramatically decreased the rates of the disease in the United States, particularly among children.

Conclusion

Hep B is a serious disease. If one gets the chronic version, there is no cure for it. It damages the liver; about 15%–25% of people with chronic Hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even if it does not it will complicate life for the infected person. For example, someone with chronic hepatitis should avoid alcohol and should always check with their doctor or nurse before taking any over-the-counter medications or herbal supplements. This even includes medications such as acetaminophen, aspirin, or ibuprofen.

Babies can contract Hep B various ways, through contact with various bodily fluids from infected people. A baby can also contract the virus during birth, from the mother, who may be a carrier and not know about it, since carriers can be asymptomatic for a long time (20%-90% chance depending on the type of virus the mother has). Many people who have chronic hepatitis B have few or no symptoms. They may not even look sick. As a result, they may not know they are infected. However, they can still spread the virus to other people.

The Hep B vaccine can protect against the infection if given within 24 hours of the exposure to the virus. Thus the need to vaccinate immediately after birth. The chances to contract the disease, through its various infection methods, are not remote; once contracted the chance of an infected newborn to develop the chronic version are extremely high; and once the chronic version is present it cannot be cured, could lead to liver failure and cancer, and other complications. 1 in 100 people who catch Hep B will die of the disease. A few vaccine shots can prevent that from happening.